Clinical Setting-Based Medical Care of Transgender and Gender-Diverse Individuals in East Asia: A Scoping Review

Abstract

Purpose:Transgender and gender-diverse (TGD) individuals in East Asia face significant structural barriers in health care utilization, yet systematic evidence focusing on clinical delivery remains scarce. This scoping review mapped available evidence on clinical setting-based medical care utilization for TGD populations in East Asia, analyzing health care delivery models, diagnostic practices, and institutional gaps affecting service utilization within medical facilities. Methods:Following the Arksey and O’Malley framework, a comprehensive search of PubMed, Scopus, and Web of Science was conducted for original peer-reviewed studies published between January 2000 and December 2024. Inclusion criteria targeted research published in English involving TGD participants receiving medical services within East Asian clinical settings. Two reviewers independently performed study selection and data extraction, focusing on clinical characteristics, diagnostic nomenclature, and policy contexts. Results:Thirty-five studies met the inclusion criteria, primarily from university-based tertiary care settings in Japan, Korea, Taiwan, and China. Clinical care concentrated heavily on tertiary prevention, such as surgical interventions and hormone therapy, while primary prevention and long-term rehabilitative care were significantly underrepresented. Diagnostic terminology showed marked heterogeneity, with many institutions still relying on pathologizing frameworks. Insurance coverage for gender-affirming care varied widely, reflecting fragmented legal and institutional recognition across the region. Conclusion:Research on TGD health care in East Asia is largely restricted to specialized tertiary centers, highlighting an urgent need for evidence from primary and community-based clinical settings. To ensure equitable medical care, regional health care systems must prioritize inclusive clinical protocols, standardized terminology, and expanded insurance coverage for essential gender-affirming treatments.